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T T Irvin - One of the best experts on this subject based on the ideXlab platform.
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mortality and Perforated peptic Ulcer a case for risk stratification in elderly patients
British Journal of Surgery, 2005Co-Authors: T T IrvinAbstract:In a consecutive series of 284 patients with a Perforated peptic Ulcer (229 pyloroduodenal, 55 gastric) there was a 26 per cent hospital mortality rate, and patients aged greater than or equal to 70 years (n = 176) had a significantly higher mortality rate (34 per cent) than patients aged less than 70 years (14 per cent, P less than 0.001). Multiple clinical variables were significantly more common in the elderly group of patients (65 per cent), in those having non-steroidal anti-inflammatory drugs or steroid therapy (56 per cent), in patients where there is an absence of a previous dyspeptic history (69 per cent), and when risk factors such as delayed presentation (33 per cent) and the presence of shock on admission to hospital (27 per cent) are present. Definitive operations (vagotomy or gastrectomy) had an increased mortality rate in the elderly (P = 0.018). Risk scores based upon the presence of shock, delayed presentation or concurrent medical illness could have predicted 87 per cent of postoperative deaths in elderly subjects, and it is suggested that risk stratification and greater caution in the use of definitive operations for Perforated Ulcer may result in a reduction in the high mortality rate in elderly subjects.
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abdominal pain a surgical audit of 1190 emergency admissions
British Journal of Surgery, 2005Co-Authors: T T IrvinAbstract:In an audit of 1190 emergency admissions with abdominal pain (1166 patients) in a general surgical unit, the diagnosis was non-specific abdominal pain (NSAP) in 415 (35 per cent), acute appendicitis in 200 (17 per cent) and intestinal obstruction in 176 (15 per cent). The largest number of admissions occurred in the age groups 10-29 years (31 per cent) and 60-79 years (29 per cent). Surgical operations were performed in 551 patients (47 per cent) and there was a 16 per cent incidence of unnecessary appendicectomy (22 per cent in the age group 20-29 years). Fifty-one deaths resulted in a 30-day hospital mortality rate of 4.4 per cent and a perioperative mortality rate of 8 per cent. The mortality rate increased significantly in patients aged greater than or equal to 60 years, and patients aged 80-89 years had a perioperative mortality rate of 20 per cent. The causes of perioperative death included laparotomy for inoperable disease (28 per cent), ruptured abdominal aortic aneurysm (23 per cent), Perforated peptic Ulcer (16 per cent) and colonic resections (14 per cent). The perioperative mortality rates for ruptured aneurysm and Perforated Ulcer were 71 and 23 per cent respectively. The duration of inpatient stay increased significantly with the age of the patients, including those with NSAP. The results of the study indicate a need to review the methods of management of ruptured aortic aneurysm and Perforated peptic Ulcer, the methods of diagnosis of appendicitis, particularly in young females, and the factors that determine the duration of stay of patients suffering from NSAP.
Perola Park - One of the best experts on this subject based on the ideXlab platform.
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self expandable metal stents as a new treatment option for Perforated duodenal Ulcer
Endoscopy, 2012Co-Authors: Maria Bergstrom, J Arroyo A Vazquez, Perola ParkAbstract:Primary stenting and drainage has been shown to be an effective and safe way to treat esophageal perforations and anastomotic leaks after gastric bypass surgery. We present a case series of eight patients with Perforated duodenal Ulcers treated with covered self-expandable metal stents (SEMS). The first two patients received their stents because of postoperative leakage after initial traditional surgical closure. The following six patients had SEMS placed as primary treatment due to co-morbidities or technical surgical difficulties. Endoscopy and stent treatment in these six patients was performed at a median of 3 days (range, 0 – 7 days) after initial symptoms. Six patients had percutaneous abdominal drainage. Early oral intake, 0 – 7 days after stent placement, was possible. All patients except one recovered without complications and were discharged 9 – 36 days after stent placement. This series indicates that primary treatment with SEMS and drainage might be an alternative to surgery in patients with Perforated Ulcer disease.
Toshiaki Watanabe - One of the best experts on this subject based on the ideXlab platform.
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Laparoscopic omental patch repair for Perforated peptic Ulcer.
Annals of Surgery, 1995Co-Authors: Masao Matsuda, Motoharu Nishiyama, Tsunekazu Hanai, Satomi Saeki, Toshiaki WatanabeAbstract:OBJECTIVE: The authors' initial experience with laparoscopic omental patch repair for Perforated peptic Ulcer is documented. Its results are compared with those of other procedures and follow-up study is reviewed. SUMMARY BACKGROUND DATA: Since the advent of H2-antagonists, the usefulness of simple closure of a Perforated peptic Ulcer is increasing, and improvements in laparoscopic surgery have made possible minimally invasive surgery for Perforated Ulcer. METHODS: From December 1992 to February 1994, laparoscopic omental patch repair followed by use of H2-antagonists was performed successfully in 11 patients. Fifty-five patients underwent other surgical procedures for Perforated peptic Ulcers (conventional open omental patch: 4, selective vagotomy in combination with antrectomy: 24, distal gastrectomy: 27). RESULTS: The average operation time was 135 minutes. Administration of postoperative pain medication was reduced remarkably (0.9 times per patient), and all patients recovered rapidly. No serious postoperative complications were recorded. After a mean period of 11 months, the postoperative evaluation was satisfactory for all patients, and no Ulcer recurrence was found. CONCLUSIONS: In Perforated peptic Ulcer disease, laparoscopic omental patch repair offers a number of advantages. Because no upper abdominal incision is made, there is decreased postoperative pain, and the patient rapidly recovers with fewer and less severe complications. Although the procedure requires a surgeon with particular expertise in endoscopic suturing technique, surgeons familiar with laparoscopic cholecystectomy can readily perform it after some practice. The authors' preliminary experience suggests that this is a minimally invasive procedure for Perforated peptic Ulcer that offers an attractive alternative to open surgery.
Christian Gerspach - One of the best experts on this subject based on the ideXlab platform.
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Ultrasonographic documentation of type-3 abomasal Ulcer in a cow with left displacement of the abomasum
Acta Veterinaria Scandinavica, 2020Co-Authors: Christian Gerspach, Carina Oschlies, Jasmin Kuratli, Ueli BraunAbstract:Background Ultrasonographic documentation of Perforated abomasal Ulcer has not been published till now. This report describes the clinical, ultrasonographic and postmortem findings in a Jersey cow with type-3 abomasal Ulcer and left displacement of the abomasum (LDA). Case report The main clinical findings were abnormal demeanour, rumen atony and tympany, positive foreign body tests, positive auscultation and simultaneous ballottement on the left side, abdominal guarding and loss of negative pressure in the abdominal cavity. The tentative diagnosis was peritonitis and LDA. Abdominal ultrasonography produced images typical of LDA, and in one location between the abdominal wall and abomasum there was a layer of fibrin, a fibrin clot, a break in the abomasal contour, suggestive of a Perforated Ulcer, and partial obstruction of this gap with fibrin. The diagnosis of Perforated abomasal Ulcer with subsequent peritonitis was confirmed during postmortem examination. Conclusions The examination of this case shows that under certain circumstances, ultrasonographic imaging of a Perforated abomasal Ulcer in a cow is possible. Antemortem diagnosis of type-3 abomasal Ulcer is preferable to relying on exploratory laparotomy and/or post-mortem examination.
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type 5 abomasal Ulcer and omental bursitis in 14 cows
Acta Veterinaria Scandinavica, 2020Co-Authors: Ueli Braun, Christina Reif, Monika Hilbe, Christian GerspachAbstract:Type-5 abomasal Ulcer (U5) is a Perforated Ulcer that causes peritonitis limited to the omental bursa. This retrospective study describes the clinical and laboratory findings in 14 cattle with omental bursitis due to U5. The medical records of 14 cows aged 2.5 to 14.6 years (5.4 ± 3.1 years) with U5 were scrutinised. The most common clinical findings were partial or complete anorexia (100%), abdominal guarding (100%), obtunded demeanour (93%), congested scleral vessels (79%), tachypnoea (71%), rumen atony (64%), diminished faecal output (64%), reduced skin surface temperature (64%) and fever (46%). Four (29%) cows had between one and four concomitant diseases. The most common abnormal laboratory findings were hypokalemia (71%), haemoconcentration (57%), metabolic acidosis (57%) and azotaemia (43%). All cows were euthanased; five immediately after the initial examination, one after exploratory laparotomy and eight after unsuccessful treatment. A diagnosis of U5 was made in all cows during postmortem examination. There is a need for improvement of the antemortem diagnosis of U5 because reliable differentiation of this disease from other conditions with a similar clinical presentation is currently not feasible.
Maria Bergstrom - One of the best experts on this subject based on the ideXlab platform.
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self expandable metal stents as a new treatment option for Perforated duodenal Ulcer
Endoscopy, 2012Co-Authors: Maria Bergstrom, J Arroyo A Vazquez, Perola ParkAbstract:Primary stenting and drainage has been shown to be an effective and safe way to treat esophageal perforations and anastomotic leaks after gastric bypass surgery. We present a case series of eight patients with Perforated duodenal Ulcers treated with covered self-expandable metal stents (SEMS). The first two patients received their stents because of postoperative leakage after initial traditional surgical closure. The following six patients had SEMS placed as primary treatment due to co-morbidities or technical surgical difficulties. Endoscopy and stent treatment in these six patients was performed at a median of 3 days (range, 0 – 7 days) after initial symptoms. Six patients had percutaneous abdominal drainage. Early oral intake, 0 – 7 days after stent placement, was possible. All patients except one recovered without complications and were discharged 9 – 36 days after stent placement. This series indicates that primary treatment with SEMS and drainage might be an alternative to surgery in patients with Perforated Ulcer disease.